Statins in primary prevention: umbrella review finds mixed evidence

Takeaway

• Evidence is limited supporting statin effectiveness for primary prevention, according to this overview of systematic reviews.
• Authors say that each decision should incorporate the patient’s baseline risk, risk reduction, and consideration of harms vs benefits, especially with a lifelong commitment.

Why this matters

• As the authors note, the question for the clinician remains: what information is relevant for each patient?
• They say that the most pertinent information may relate to outcomes based on baseline risk and sex and that comparing decisions based on upper and lower 95% CI boundaries might be informative.

Key results

• 3 systematic reviews included, with mixed quality.
• 2 analyzed data from 14 randomized controlled trials; 1 analyzed individual patient data from 22 trials.
• Trend to decreased all-cause mortality collectively, with relative risks from 0.78 to 0.91, but 2 failed to meet significance.
• With stratification by baseline risk, most significance associating statins with reduced all-cause mortality disappeared.

Study design

• Overview, 3 systematic reviews, with data analysis, narrative synthesis.
• Funding: Authors report individual funding.

Limitations

• Systematic reviews had mix of individual patient and group-level data.
• Some relevant reviews might have been excluded because primary prevention participants could not be ascertained.
• Only 1 included review reported bias risk.